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COVID: Chance to Rethink Work Comp

As insurers worry that the pandemic is depressing premiums, here is a way to rethink workers' comp -- and two entirely new product ideas.

Workers' compensation pre-COVID was an extremely competitive market and now, as we’re in the midst of COVID, continues to be a highly competitive line of business. With declining payrolls, insurers are looking for ways to differentiate and retain their existing book of business while finding ways to attract and grow new business.

Well, I have an idea for you. It’s an entirely new product for workers' compensation.

You may be asking: How can that be? Workers' compensation is defined by law, right? It’s a state-mandated program consisting of payments required to be made to an employee who is injured or disabled in connection with work. The coverage is mandated by law, the benefits are defined by law and the rates are determined by law. So how can you create a new workers' compensation product?

Well, what if you redefined the product? What if instead of saying, “Our goal is to provide employers with the means to meet their legally mandated requirements,” you instead said, “Our goal is to help the citizens of our state(s) recover when an employee is injured”? That change in wording suddenly opens up a wide variety of other benefits that could be provided. You can think of it as two new endorsements that wrap around the traditional workers' compensation coverage.

The first endorsement is what you can think of as Employee Plus. Similar to accident insurance, which wraps around a traditional health policy and provides additional benefits for a fee, Employee Plus could provide additional benefits for a fee – for the kinds of expenses that employee incur when injured. For example:

  • Transportation expenses for family members trying to get to the hospital or to the pharmacy to pick up a prescription or for the injured worker to get to physical therapy visits.
  • Childcare reimbursement for family members who are at the hospital with their injured family member and are unable to care for children.
  • Costs for food delivery for family members who no longer have time to prepare meals. Even just a few meals could help.
  • Housekeeping, gardening or laundry services that may be needed when a family member is either injured and unable to perform these tasks themselves or are spending their time caring for the injured family member.
  • Family therapy – to deal with the aftermath of the injury.
  • Spousal retraining – for those who now have to go back to work or find new ways of generating more income as the employee is injured.
  • Remodeling expenses for a home – if the injured worker is severely disabled and can no longer easily navigate through a home. Ramps, wider doors and remodeled showers can all be key to allowing an injured worker to stay in their home.
  • College scholarships for the children of injured workers

You get it: the kinds of out-of-pocket costs that only occur if someone is injured. There’s probably a zillion other options that could be provided – or an insurer could choose a subset of these to provide. These benefits would be small fixed limits and may be triggered by the level of injury. A permanent total injury might trigger a $10,000 scholarship where a temporary partial would not. The employer could choose to offer one or more of these and could choose the limit it wants to provide injured employees. What a great employee benefit an employer could offer to attract or retain employees.

Similar to Employee Plus, an insurer could launch Employer Plus, to cover the kinds of additional expenses an employer incurs when an employee is injured. Examples might be:

  • Public relations support should the accident hit the news and create a reputation risk.
  • Therapy for employees who witnessed the accident.
  • Costs for equipment needed if a job needs to be redesigned to accommodate the worker.
  • Staff augmentation reimbursement to cover the salary of a temporary replacement worker.
  • Head hunter fees – to cover the costs of finding a permanent replacement.

There are likely a number of additional options that could be provided on a fixed limits basis and triggered by the severity of the injury. Today, workers' compensation provides no recovery solutions for the employer - it only covers the injured workers. But put yourself in the place of the employer or the injured worker, identify all the hidden costs and irritants -- and, voila, you've found a new product.

See also: Big Changes Coming for Workers’ Comp

Our work on customer experience shows that while many insurers are focused on making the process fast and easy, customers also expect help recovering from their losses -beyond a simple check. And while some insurers provide some of these services outside of the contract when they feel it is warranted, there is no reason that you couldn’t explicitly offer these coverages and generate a little revenue while demonstrating that you truly care about their recovery.

Hoping this idea triggers some insurers to consider new ways of differentiating themselves in a highly regulated product line. And feel free to reach out if you want to brainstorm on this some more!

This blog entry has been reprinted with permission from Celent.


Karlyn Carnahan

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Karlyn Carnahan

Karlyn Carnahan is the head of the Americas Property Casualty practice for Celent. She focuses on issues related to digital transformation. Carnahan is the lead analyst for questions related to distribution management, underwriting and claims, core systems and operational excellence.

Agents Must Better Explain Their Value

If you can't make your case, then better marketers will convince consumers they are more ethical than you.

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If agencies can't do a better job of explaining their value, better marketers will convince consumers they are more ethical than you.

A recent press release from an insurtech caught my attention and ire. What first caught my eye was how the startup measured success in coverage placed, i.e., total policy limits rather than premiums or commissions, to make themselves look successful. For people who don't know the difference, it was impressive that a 12-person startup agency could place $2 billion in coverage in four years! The average 12-person agency only has $1.2 million to $1.6 million in revenue. This insurtech is outperforming the average agency by 1,430 times!

$2 billion in coverage at $1 million in liability only is just 2,000 policies. Assuming there is some auto and comp and whatever else in there, let's say 1.5 policies per customer; that is only 1,333 customers; or, in other words, they basically wrote one account per day over four years. Those kinds of policies average around $500 commission each, which may be generous but I'll use that figure. That amounts to $667,000 in revenue. Divide that by 12 people, and the result is $55,000 revenue per person.

Insurtech is supposed to be about scale. The definition of scale, in all directness, is doing more with fewer people. Scale is nothing else. $55,000 in revenue per person is not scale.

What next caught my attention was their statement that the traditional insurance model provides agents incentives to sell customers policies they don't need or contain inflated coverage limits. I'd really like to see solid proof that this regularly occurs. I don't know the captive agent world well, so maybe it happens there, but I doubt it. I know the independent agency world extremely well, and I have rarely seen this happen.

The system actually works the opposite of their statement. In the traditional agency model, for many complex and intertwined reasons, agents actually have more incentive to sell clients less coverage than they need even though they are threatened with E&O suits for doing so! I have seen a large number of agents sued for not selling adequate limits or the right coverages. In the COVID-19 world, has anyone seen an agent sued for selling too much business income insurance?

For 25 years, I have been cajoling, arguing, demanding, yelling and screaming at agents to use coverage checklists, and yet agents are no more likely to use coverage checklists today than 25 years ago. (I'm a failure!) It has been proven over and over in E&O studies that using coverage checklists to ensure clients are offered adequate coverages is the best solution for both clients and agents!

I have only seen one suit brought in the independent agency world for selling too much insurance, and the suit was aimed at the carrier because it was the carrier's practices, not the agencies' practices, that allegedly resulted in excessive and unnecessary limits. I've never even heard of an agent being sued for selling clients too much insurance.

This insurtech advised that their model works because they make up the difference with finance fees. Their story sounds great to a large proportion of consumers. Consumers do not know how much insurance they need because no agent has ever educated them on how much insurance they need. I teach a lot of insurance classes and have conducted a lot of E&O audits; few people ever discuss the importance of drop down UM coverage on an umbrella policy (in fact, many agents and customer services representatives don't even talk about the importance of an umbrella policy). Selling unnecessary coverage is really, I mean really, really hard when most agents do not even offer necessary coverage. I was with a retired family member who had paid off his mortgage and wanted to drop his homeowners' insurance. I explained he would lose his liability coverage. This is an extremely smart person and yet not one single agent in 40 years had ever explained the importance of liability coverage to him!

Professional agents will lose if they don't educate their clients as to why they need more coverage. They will lose to agents who actually advise those same clients, who do not have enough insurance, that their incumbent agent has actually sold them too much coverage! Pay for what you need, they say, but the consumer has no idea what they need!

See also: 4 Post-COVID-19 Trends for Insurers

A huge proportion of producers exacerbate this problem when their client asks, "How much liability should I purchase?" The producer frequently answers, "As much as you can afford." What is the difference between this "professional" advice and insurtechs' advertising, "Buy as much as you can afford." It's the same advice! The correct response is to help your customer figure out what they can afford to lose and then recommend that they buy an appropriate limit.

The insurtech's press release articulates so much of what I see as wrong and unfair in this industry. Yet, the failure of agents to educate their clients and offer the right coverages and their own lack of knowledge about coverages has opened the door wide for this kind of upside-down and sideways marketing pitch to actually make sense to consumers. A low down payment with significant finance fees has been a successful business model for a long, long time.

One other possibly dubious claim is that insureds will still save 35% because carriers are willing to reduce their price because the insurtech agent is so efficient. This claim may be true in some instances because reducing acquisition cost is a huge goal for carriers today. However, a 35% savings? Let's do the math on this:

The industry average loss ratio has been 61% over the last five years. The average profit margin is around 10%, including investment income. Independent agents are paid an average of around 13%, including comp. So, no matter what an agent does, the most carriers can save is 13% by eliminating agency compensation. An argument may exist relative to some additional savings relative to frictional costs, but not enough. The carriers' average total expense ratio is around 28% excluding LAE. If I remove the commission of 13%, that only leaves 15%. A 35% reduction in expenses is impossible.

Additionally, using a 61% loss ratio, and if the rate is 35% less, the loss ratio would be 96%, all else being equal. Even if all commissions are eliminated, the loss ratio is still 83%. An 83% loss ratio is not sustainable.

Now, maybe the quoted 35% savings is meant to mirror other disingenuous price saving advertising such as, "The average customer who switched saved $350!" That is an entirely pointless but quite effective ploy. Let's say 1,000 people shopped that carrier's site, and 990 stayed with their existing carrier. The remaining 10 saved an average of $350. The people who did not switch may have saved an average of $350 by not switching, so they did not switch! Only counting one side of a ledger is illegal in finance, and perhaps advertising rules should be revised along the same lines. Either way, advertising that carriers are offering lower rates when it is just a math gimmick is mixing and matching in a manner that is highly questionable.

A true 35% savings from the same carrier requires special filings by that carrier or the use of a special purpose PUP company with previously filed deviated rates. That is an awful lot of work for a startup agency that has so little commission they announce sales in total policy limits.

See also: 10 Tips for Moving Online in COVID World

Always check the math on claims like this startup's. More importantly, sell the right coverages, educate your clients on how much coverage they actually need and show them you won't sell coverages they do not need. Don't let firms like this insurtech beat you.

You can find this article originally published here.

5 Hurdles to Insurtech Success

Here are five things that stand between insurtechs and success -- but, please note, your mileage may differ.

We like to joke that we started an insurtech because we wanted to make money as slowly as possible. It’s an exceedingly painful joke.

We were asked recently to discuss issues that insurtech companies face. We came up with five things that stand between insurtechs and success. Here they are, but, please note, your mileage may differ.

1) The math – All insurtechs have one super-challenging math equation to overcome –

Risk = Bad

Insurtech = Risk

Therefore, Insurtech = Bad

Insurtechs are busy trying to make themselves more inventive. Which only makes them riskier. As this equation shows us, that’s a bad thing. Much more attention needs to be paid to how insurtechs can de-risk themselves and make it easier for insurance professionals to rely on them.

2) Insurtechs are talking revolution to an industry that makes evolution look fast. Most insurtechs believe that they are going to revolutionize the insurance industry. Unfortunately for the revolutionizing insurtech, insurance has been around for 300 years without them and can probably be around for another 300 years without them. Insurance is an incremental improvement industry. It’s evolution over revolution.

3) Insurtechs don’t understand who they’re selling to. If you’ve never been to an insurtech pitch-fest, it’s filled with T-shirt and torn jeans entrepreneurs pitching to suit-and-tie-wearing insurance executives. We’re not saying that the insurtechs should be wearing suits, but a nice pair of pants and a coat wouldn’t hurt you. And we’re not even broaching the subject of industry knowledge here.

See also: Insurtechs Are Specializing  

4) Insurance companies are slow. When an insurance company talks about doing something this year, the earth will revolve three times around the sun before that something happens. They’re called insurance-years. They’re like dog-years but in reverse. Insurtechs have to plan for their first real sale being three years away, not three months. Blaming carriers for their slow sales cycles means you haven’t prepared properly.

5) Even the best mousetrap will not cause insurers to beat a path to your door. Insurance companies and the law of large numbers work together very well to make money. It’s very hard to break through the status quo, even with the latest and greatest whatever-it-is. Insurance employees aren’t normally rewarded for taking chances on something unproven. This lack of urgency to do something different can kill your insurtech.

Success IS possible in insurtech! Between new data, new processes and interesting technologies, insurtechs ARE winning. By understanding some of the hurdles you’ll face before achieving success, you might be able to shave some time off one of the most daunting sales challenges ever invented – selling to the insurance industry. Good luck, and we’ll see you in the marketplace!

This article was originally published on HazardHub.

An Inconvenient Sales Truth

It is no longer enough to show up with a fancy spreadsheet, promises of better service and a capabilities presentation.

When discussing acquisition strategy with producers, I’ll often hear them say, “Yeah, we compete on price, but we retain on service.”

The fact they even make this statement is a sign they know price alone isn’t enough. Yet, they don’t take the time to build a sales process that takes the decision away from price alone.

Price is always a factor; however, in most instances in this industry it is the level playing ground. With precious few exceptions, brokers have access to the same carriers, same plan designs and same prices. By admittedly competing on price, brokers/advisers never give themselves a fair shot at earning new business. This is why close ratios and new business volumes in most instances are way too low.

At least when it comes to fully insured plans, isn’t getting quotes one of the most basic tasks a broker does? By “basic,” I don’t necessarily mean it’s easy, but being able to get quotes and negotiate the renewal is, undoubtedly, a minimum expectation that business owners have of their adviser.

In baseball, the tie goes to the runner. The “runner” in our game is the incumbent broker who will almost always win the spreadsheet game.

You retain on what?

Now, let’s talk about the “we retain on service” declaration. Once again, isn’t this just another minimum expectation a business owner has of an adviser? Don’t they expect you to fix problems, advocate on their behalf and respond quickly?

Now, put both of these back together. If a business owner was working with an adviser who wasn’t able to handle the renewal effectively or who didn’t provide good service, what do you think the owner would do?

No doubt, the owner would fire the adviser in a heartbeat. The owner would fire the adviser because he wasn't even meeting the minimum expectations.

Service PLUS

Some try to use a capabilities presentation as a tie-breaker. They accumulate a long list of “value-added services” (we prefer to call them non-insurance solutions) and drone on and on about all the extra stuff they provide their clients.

See also: Will COVID-19 Spur Life Insurance Sales?

Guess what? In today’s benefits’ world, that list of stuff is now part of the minimum expectations. If you don’t have the tools, don’t even bother showing up for the job.

Sure, you will occasionally win with the spreadsheet when going against a way-too-traditional broker. You may even catch the incumbent asleep at the service wheel and pick up an account that way from time to time. And, just maybe, you were an early adopter for that very solution an employer wants but hasn’t yet been offered. It does happen, just not often enough.

Don’t find a false sense of security from those occasional wins.

The universe insists on balance

Here’s the reality of client attraction and retention. You will lose every account the same way you won it. This happens because you train clients on how to buy based on the way you sell to them in the first place.

The most hypocritical of all are “spreadsheeters,” who are offended when a client asks other brokers to quote at renewal. Who do you think taught them that?!

Advisers whose value proposition is limited to the price of the insurance product and fixing stuff when it breaks are effectively saying, “Hire me because I can meet the minimum expectations better than your current guy/gal.”

A subtle but profound shift

We’ve already agreed, price is important. However, what is way more important than the price on the spreadsheet is an adviser’s ability to put together an overall cost control strategy. THIS is what should be discussed during the sales process. The spreadsheet is simply a lagging indicator (yes, I know underwriters are predicting future claims) of what has already happened. You should be competing based on your ability to develop a strategy that will help moving forward.

We also agree the non-insurance solutions in your capabilities binder are essential. However, just scrolling through the list of what you have to offer leaves you sounding like every other broker.

It’s time to dig into those solutions the way they were intended to be used. After all, you invested in them because they solve real problems faced by clients. Put yourself in the seat of that buyer. Do you think the buyer is more interested in listening to your we-have-it-too list of resources or in the list of problems they are struggling with that they need to solve? No-brainer, right?!

See also: Crisis Mitigation Beyond COVID-19

Don’t be lazy

This isn’t some profound insight, I know. However, most of your competitors are taking the lazy route to new business. Genuinely solving an expanding list of problems takes work. It is no longer enough to show up with a fancy spreadsheet, promises of better service and a capabilities presentation.

Make yourself the painfully obvious choice. Your new business acquisition strategy must be built on proving you can continually deliver better results than anyone else. When this is the way you acquire new business, when it’s the client experience you provide, you will find yourself losing fewer and fewer clients.

You can find this article originally published here.


Kevin Trokey

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Kevin Trokey

Kevin Trokey is founding partner and coach at Q4intelligence. He is driven to ignite curiosity and to push the industry through the barriers that hold it back. As a student of the insurance industry, he channels his own curiosity by observing and studying the players, the changing regulations, and the business climate that influence us all.

COVID-19 Sparks Revolution in Claims

The pandemic has pushed workers' comp toward telehealth, which is revolutionizing the claims process in four key ways.

While coronavirus news is often bleak and sometimes downright depressing, there may be a silver lining for claims management. The global pandemic has pushed the importance of virtual care and claims management technology to the forefront. It has ignited a fire in the workers’ compensation industry, inspiring companies to find ways to quickly identify and safely treat cases, while minimizing the spread of the virus. 

COVID-19 has revealed the importance of a claims management process that is transparent, data-driven and accessible to all stakeholders. From expanded telehealth options to the newest technology in claims management, including integrated platforms and patient-focused tools, the workers’ compensation industry is evolving. 

The future of claims management and virtual care leverages innovative technologies and artificial intelligence, and it is catching fire across the industry. Here are some examples of the revolutionary trends in claims management:

#1. Telehealth is HOT

While telehealth was introduced for workers’ compensation cases about six years ago, the journey to adoption has been slow and bumpy as employers and injured workers were hesitant to make the virtual leap. Before the pandemic, only 8% of Americans had ever used telemedicine, but that changed almost overnight with some medical providers reporting up to 95% of post-COVID-19 patient visits now being conducted virtually.  

Telehealth allows injured workers to quickly connect to providers via telephonic evaluations and video visits. Injured workers can be seen much faster, especially those who may be remote, at a distance from existing medical facilities, or working during off hours. 

Since its introduction, telehealth has significantly improved workers’ compensation management and the care of injured workers. According to CorVel, a national provider of risk management solutions that was among the first to launch telehealth services in workers’ compensation, data measuring the impact of telehealth programs over a five-year period showed:

  • Treatment wait times have been reduced from an average of two hours to 10 minutes
  • Treatment costs have been reduced anywhere from $100 to $850 per visit, depending on the specialty, with improved quality of care
  • The number of unnecessary medication prescriptions has been reduced by nearly 50%
  • Patient satisfaction rates have improved from 3.65 to 4.8 on a scale of 1 to 5

See also: COVID: Agents’ Chance to Rethink Insurance

#2. As COVID-19 Rages, Telehealth Expands to Create End-to-End Solutions

As private insurers and public health programs, including Medicare and Medicaid, are now providing reimbursement for remote office visits, at-home patient monitoring and physician-to-physician consults, it is clear that telehealth is here to stay. However, COVID-19 has forced us to move past traditional telehealth to address the full episode of care—from beginning to end. 

Expanded virtual care solutions provide the ability to engage the injured worker, treat the injury or illness and manage care remotely, minimizing the risk for all parties involved. From initial injury or exposure to return to work, virtual services are playing a role to ease the process for claims management professionals, employees and payers and the injured worker:

  • From the first moment of an injury or exposure, communication is critical, especially in the midst of a pandemic. Virtual 24/7 nurse triage is being used more than ever to connect injured workers with a registered nurse for immediate medical evaluation and care direction. Companies have also implemented special hotlines for employers and employees who present with COVID-19 symptoms or who need additional information. 
  • After being screened by a triage nurse, telehealth connects injured workers with a provider through a virtual visit via a computer or smart device. The virtual visit facilitates more immediate care for remote workers or those who are required to shelter in place. Patients who need testing are directed to a provider who manages the process to minimize the potential for infection and the possible spread of the disease. Follow-up protocols are being put in place for infected patients, making sure they get support and education throughout the incubation period. Remote care and communication ease this process and keep employees and providers safe.
  • Injured workers’ with more complex care or continuing needs can also benefit from virtual services, including rehabilitation by telehealth, video medical visits, home delivery of prescriptions and durable medical equipment and coordination of any diagnostic testing to aid a rapid return to work and minimize exposure to the virus. 
  • When it’s time to return to work, virtual services help companies perform employee assessment screenings and provide education to promote a safe workspace based on CDC guidelines. 

#3. Connecting the Dots: Integrated Claims Management and Artificial Intelligence

While telehealth has made major strides during the pandemic, it is the combination of big data, artificial intelligence and telehealth that is now delivering new improvements in care and claims management. An integrated platform with the ability to manage the full episode of care through one system simplifies workflows, allowing claims professionals more time to focus on the injured worker, while delivering patient-centered engagement, and prompt, open communication for all stakeholders

The application of artificial intelligence combined with big data can catch potential flags and danger signals much faster than a busy claims professional reading reams of text and reports. Leveraging big data and artificial intelligence overcomes the hurdle of significant delays before relevant data is identified, analyzed and acted upon. By quickly analyzing multiple data streams to identify specific patterns and flag potential snags, AI-driven analytics can provide an early warning system that gives claims handlers, case managers, and medical providers actionable information to speed up and smooth out the claims resolution process and ensure that the patient gets the best care, reducing the likelihood of complications, friction and a costly and drawn-out claim.

Instead of spending hours reading through notes and documents to get a picture of the injured worker’s progress, a direct communication alerts stakeholders to a development in the injured workers’ condition that needs immediate attention. 

For case managers and claims adjusters, the ability to automatically identify problems that would have required hours of searching for in notes and files is a huge boon to their efficiency and job satisfaction. Now, they can focus on problem-solving for the injured worker versus being consumed by data and paperwork. 

  • One example of how prescriptive analytics is being used is to evaluate the morphine equivalency of a patient’s medications to detect emerging problems. When a certain threshold is reached, the claims professional receives an automated notice in real time, allowing for immediate intervention to find safer options for pain management. Pairing this will telehealth allows us to offer a biopsychosocial solution for care management versus just the bio-medical model.  

#4 Technology With Heart

To improve case management even further, companies are finding ways to put the thought process of nurses and claims experts at the center of technology. This unique case management codification is changing how claims are managed and improving the claims management process for nurses, claims management professionals, employers and the injured workers. 

Traditional case management reporting has been notorious for voluminous documentation outlining the status and activity of the case manager, requiring the reader to dedicate hours of reading only to try to decipher the significant details and navigate through the medical jargon and abbreviation contained within the report. The value of case management was measured more on words per page versus actual interventions and outcomes.

New codification, leveraging the nurses' thought process, gives claims professionals the information needed to act quickly without the lengthy process of reading through extensive notes and documentation. It identifies risk and flags potential snags, providing an early warning system that provides actionable information to speed up and smooth out the claims resolution process and ensure that the patient gets the best care. Instead of spending hours reading through notes and documents to get a picture of the injured worker’s progress, claims managers can get direct communication alerting them to a development in the injured workers’ condition that needs immediate attention.

  • For example, codification can alert the claim administrator of pain that is preventing the injured employee from returning to work. The platform immediately notifies the claim administrator when an injured worker is expected to recover but is experiencing decreased function due to pain. Actions are recommended based on data entered by the nurse case manager. This allows the claims administrator to promptly address potential issues that may impede restoration of  the injured worker’s comfort and function. The prompt response can help the employee heal and get back to work as quickly as possible. 

This innovative technology reduces disability duration, improves return-to-work and stay-at-work outcomes and lowers claims costs like never before. In fact, cases referred less than 30 days from date of injury result in 30% higher savings on average, and litigation rates are decreased about 50% when cases are referred to case management within the first 7 to 30 days.

See also: The Case for Paying COVID BII Claims  

What’s Next?

COVID-19 is a reminder that behind every claim is an incredibly valuable worker who needs attention from the first moment an incident occurs. With innovative integrated technologies, we have the ability to keep workers safe and provide exceptional care by leveraging virtual tools and enabling end-to-end care. As telehealth has risen to the forefront during this crisis because of its ability to provide the best care possible at any time and from any location, it is also inspiring several other advancements that will enhance patient care, including:

  • Patient specificity, matching patients with the “right provider,” is on the rise and already being implemented to provide Spanish-speaking workers with a Spanish-speaking nurse and provider. At CorVel, this patient specificity matching is already happening for 85% of Spanish-speaking injured workers. In the future, telehealth will allow us to analyze the specific needs of a patient and then match that patient with the right provider for the case. 
  • Second opinions via telehealth allow us to confer with some of the top specialists in the country, who have no financial interest in the outcome, in order for the patient to make the best care decisions. Anyone who has been through a surgery has seen that the shared decision making on the risk-reward of the procedure is handed to you on a clip board as you are about to be wheeled into the OR. Having an expert second opinion will help guide treatment decisions and put the patient’s mind at ease.
  • As telehealth is expanding to specialists so are the peripheral devices designed to support care in this medium. A great example is the use of Tyto-care, which connects to a smart phone to allow pediatrics to see inside the patient’s ear or throat remotely. As demand for telehealth increases, we can expect to see more FDA-approved devices available to support virtual care.   

Telehealth will remain a critical tool for managing workers’ compensation cases even after COVID-19 because of its ability to reduce costs, improve satisfaction, and keep workers safe. This combination of virtual services to manage care remotely, patient-centered engagement and prompt, open communication for all stakeholders is changing the way claims are managed and is the future of claims management.

Six Things Newsletter | August 11, 2020

In this week's Six Things, COVID-19 and the long slog ahead. Plus, why WFH threatens innovation, how insurers are applying AI, 5 things here to stay post-pandemic, and more.

In this week's Six Things, COVID-19 and the long slog ahead. Plus, why work-from-home threatens innovation, how insurers are applying AI, five things here to stay post-pandemic, 'scalable compassion' in workers' comp, and more.

COVID-19: The Long Slog Ahead

Paul Carroll, Editor-in-Chief of ITL

While sorting through the latest studies and projections about the path of the coronavirus this past week, I was hit in the face with a veritable two-by-four by a piece in Medium by my old friend and colleague Sam Hill. Sam, an all-around smart guy who may be known to some of you because of some high-impact consulting he’s done in the insurance world, writes that, even under the best of scenarios, we’re probably looking at the end of 2021 before the world might return to normal.

Let that sink in for a minute. More than 16 more months of this, in one form or another... continue reading >

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SIX THINGS

Why Work-From-Home Threatens Innovation
by Stephen Applebaum

Non-insurance competitors such as Amazon, Google, Tesla, Comcast, General Motors and many others are not standing still, and neither should insurers.

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How Insurers Are Applying AI
by Tiffany Wang and Jeff Goldberg

Insurers should not invest in technology-driven projects; instead, look for use-case-driven projects.

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‘Scalable Compassion’ in Workers’ Comp
by Thomas Ash

As much as claims representatives want to help individuals, there has been no feasible way to provide compassion at scale.

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Optimizing Care with AI in Workers Comp Claims


In workers’ compensation, we've all seen seemingly basic claims morph into catastrophic claims.This free on-demand webinar, sponsored by CLARA analytics, lays out a tangible solution that realizes the promise of AI.

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Panic Pricing May Be a Bad Idea
by Wayne Allen and Guy Fraker

While raising rates might be how the industry has responded to uncertainty in the past, there are reasons not to do so now.

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Claims and Effective Risk Management
by Christopher Mandel

How you prioritize claims and related activities will have significant effects on how you can contribute to organizational success.

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5 Things Here to Stay, Post-Pandemic
by Chad Levine

While responses to where and how people work have varied, several effects on workplaces from the pandemic will persist even once it subsides.

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Insurance Thought Leadership

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Insurance Thought Leadership

Insurance Thought Leadership (ITL) delivers engaging, informative articles from our global network of thought leaders and decision makers. Their insights are transforming the insurance and risk management marketplace through knowledge sharing, big ideas on a wide variety of topics, and lessons learned through real-life applications of innovative technology.

We also connect our network of authors and readers in ways that help them uncover opportunities and that lead to innovation and strategic advantage.

COVID-19: The Long Slog Ahead

Even the best-case scenarios now suggest that it will be well into 2021 before the U.S. recovers from the coronavirus.

While sorting through the latest studies and projections about the path of the coronavirus this past week, I was hit in the face with a veritable two-by-four by this piece in Medium by my old friend and colleague Sam Hill. Sam, an all-around smart guy who may be known to some of you because of some high-impact consulting he's done in the insurance world, writes that, even under the best of scenarios, we're probably looking at the end of 2021 before the world might return to normal.

Let that sink in for a minute. More than 16 more months of this, in one form or another.

In some ways, Sam's piece strikes me as quite optimistic. He is counting on having three viable vaccines for the virus in the market by the end of this year.

But it will take months to manufacture and distribute enough to vanquish the virus. Some vaccines may not work or may have disastrous side effects, leading to caution both among public health authorities and among those of us considering getting the virus -- "In 1976," Sam writes, "one person died of a flu strain that appeared to be like the 1918 flu. We rushed a vaccine through. It killed 250 and paralyzed 500."

Even if the vaccine works, it may only be 50% to 60% effective, not 90%, as we've come to expect with smallpox, measles and polio, so a lot of people would be left vulnerable.

By the time you crank in all the steps that have to be completed before life returns to normal, Sam puts the over/under at roughly the end of 2021.

And that's the best of the three scenarios he lays out.

As long as I'm quoting people this week, here are the two smartest observations I've seen recently on how to navigate these crazy times. Both come from Kevin Sneader, the global managing partner at McKinsey:

"The first piece of advice I’d offer a CEO is, forecasts are out, dashboards are in. The notion that you can now forecast the economy, healthcare and other aspects of what can disrupt life, I think, is gone. Now we’re in an environment where we’ve also learned that what you really need to have a handle on are the metrics, insights and what’s actually happening on the ground—the dashboard of daily life.

"You really do have to think like an attacker all over again. Even if you were the incumbent, even if you were the leader before this pandemic, you’re now the attacker, so you must take the steps that attackers take. Think very differently. Look for new opportunities, new markets. Reshape the portfolio and, yes, look at mergers and acquisitions. Plan to do things quite differently as the future unfolds."

Stay safe.

Paul

P.S. Here are the six articles I'd like to highlight from the past week:

Why Work-From-Home Threatens Innovation

Non-insurance competitors such as Amazon, Google, Tesla, Comcast, General Motors and many others are not standing still, and neither should insurers.

How Insurers Are Applying AI

Insurers should not invest in technology-driven projects; instead, look for use-case-driven projects.

‘Scalable Compassion’ in Workers’ Comp

As much as claims representatives want to help individuals, there has been no feasible way to provide compassion at scale.

Panic Pricing May Be a Bad Idea

While raising rates might be how the industry has responded to uncertainty in the past, there are reasons not to do so now.

The Problem With Virtual Events

People routinely consume TED talks online and love them -- because they don’t bear any resemblance to boring, low-energy Zoom presentations.

5 Things Here to Stay, Post-Pandemic

While responses to where and how people work have varied, several effects on workplaces from the pandemic will persist even once it subsides.


Paul Carroll

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Paul Carroll

Paul Carroll is the editor-in-chief of Insurance Thought Leadership.

He is also co-author of A Brief History of a Perfect Future: Inventing the Future We Can Proudly Leave Our Kids by 2050 and Billion Dollar Lessons: What You Can Learn From the Most Inexcusable Business Failures of the Last 25 Years and the author of a best-seller on IBM, published in 1993.

Carroll spent 17 years at the Wall Street Journal as an editor and reporter; he was nominated twice for the Pulitzer Prize. He later was a finalist for a National Magazine Award.

The Problem With Virtual Events

People routinely consume TED talks online and love them -- because they don’t bear any resemblance to boring, low-energy Zoom presentations.

Are you Zoomed out? Had your fill of webinars? Well, you’re not alone.

As the conference and events industry has pivoted to virtual gatherings, it’s become increasingly apparent how unfamiliar many meeting sponsors and speakers are with the digital stage. Since the COVID-19 lockdown, I’ve attended several such events (as an audience member) and, well…  let’s just say there’s plenty of room for improvement.

Most of the events were marked by technical glitches that should have been prevented with good, thorough preparation. (One major event even managed to mess up the posting of pre-recorded segments. I understand that livestreams are a bit of a wildcard, but to not nail the pre-recorded sessions – how does that even happen?)

What’s worse, though, is that even when the A/V platforms were chugging along perfectly, the presenters weren’t.

There were mind-numbing PowerPoint slides. (Granted, that can happen at live events, too – but, boy, it sure feels more painful online.)

There were physical printouts held up awkwardly to webcams as visual aids, eliciting a flurry of chat box complaints from viewers who couldn’t make out the documents.

There were awkward webcam angles that revealed far more about speakers’ nostrils than any attendee needed to see.

There were distracting backgrounds, with speakers presenting in front of everything from cluttered home offices to gloomy basements to Zoom-generated tropical beaches.

There were light exposure goofs that made it appear that some speakers were presenting from the surface of the sun, while others were broadcasting from their closets.

And there were those little headshot video feeds of the presenter, tucked into the corner of a PowerPoint slide, looking more like a mediocre language translator than a stage-commanding keynoter.

If virtual events are to be successful (and, mind you, I think they can be), then conference organizers and speakers need to approach them less like a Zoom call and more like a TED talk.

People routinely consume TED talks online and love them. They’re engaging, they’re polished and they don’t bear any resemblance whatsoever to boring, low-energy Zoom presentations.

Of course, TED talks are recorded before a live audience, giving them a vitality that no purely virtual event can match. Nevertheless, virtual events can certainly do more to replicate the character of a TED talk, even while we might all acknowledge that it is a high bar to fully meet.

As meeting professionals and speaker bureaus look for ways to stay relevant in the midst of a travel-inhibiting pandemic, it’s incumbent upon them to guide their clients (both event sponsors and keynote speakers) in how to achieve that aspiration.

See also: Building a Virtual Insurer Post-COVID

I’ve written about this previously (“7 Ways To Make Your Virtual Conference Successful”), but, given what I’ve witnessed in recent weeks, some additional tips are in order – specifically related to how speakers present themselves during these events:

  • Stand up. Yes, you can sit down for a regular business videoconference, but to stay seated for delivery of a keynote? Absolutely not. Speakers exude so much more energy when they stand and deliver. Presuming speakers are physically able, that’s the position from which they should present.
  • Zoom out. Part of the energy that’s conveyed by a live, onstage speaker comes from body language. If the virtual keynoter has the camera or webcam set for what is essentially a headshot, then the audience loses the opportunity to see hand gestures and other physical movements that help engage viewers.
  • Go eye-to-eye. The speaker’s camera angle shouldn’t be the most intriguing part of the presentation. No one wants to see a digital keynote from the bird’s eye view of a camera positioned too high, or the nostril-revealing perspective of one positioned too low. Film at eye level (when standing, not sitting).
  • Ditch the thumbnail. It’s tough to command the digital stage when your video feed is constrained to a square inch of screen real estate on your audience’s devices. Speakers should be using livestream software to exert greater control over how their video image and presentation visuals are rendered online (e.g., full screen speaker video with cuts to visuals, or split-screens with speaker video positioned alongside visuals).
  • Swap the stage for a studio. When a live, onstage keynote isn’t possible, the most suitable replacement isn’t a laptop with a webcam and embedded microphone, positioned on a desk in a dreary office. (Imagine if TED talks were recorded that way.) World-class virtual events require something more, which is why speakers (and perhaps even showrunners and bureaus) should be investing in creating their own studios, complete with high-quality audio/video equipment, professional lighting, backdrops and all the related accessories.
  • Avoid distractions.  It can be tempting to enliven a virtual keynote with creative Zoom backgrounds, green screen effects, animations and other technological wizardry. Avoid that temptation; it gets old fast. Choose substance over sizzle. Compelling content, delivered in an engaging manner, will always win the day.

If event speakers and meeting organizers want to successfully move to a digital-first world, it’s going to require more than “phoning it in” via a traditional webinar setup. Audiences don’t want another boring Zoom or WebEx. They want a full-fledged digital event experience — as close a proxy as possible for seeing experts and luminaries onstage.

If meeting professionals and speakers don’t start delivering precisely that, then the industry’s pandemic-induced business pause will turn into a much longer and more troublesome drought.

This article was originally published here.


Jon Picoult

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Jon Picoult

Jon Picoult is the founder of Watermark Consulting, a customer experience advisory firm specializing in the financial services industry. Picoult has worked with thousands of executives, helping some of the world's foremost brands capitalize on the power of loyalty -- both in the marketplace and in the workplace.

5 Things Here to Stay, Post-Pandemic

While responses to where and how people work have varied, several effects on workplaces from the pandemic will persist even once it subsides.

The coronavirus pandemic forced a near overnight shift in how workers across swaths of industries, including insurance, work. Virtual meetings, telecommuting, a boom in remote tech – these things all became part of the everyday workplace reality in a flash and shook attitudes about what it means to be “at work and working.”   

My team and I work with a range of business owners in the insurance industry, from one-man shop independent agents and brokers to larger firms. While responses to where and how people work have certainly varied, we do anticipate that there will be several permanent side effects on insurance workplaces even after the pandemic subsides.  

1. Putting the brakes on road warriors 

Pre-pandemic, many insurance industry road warriors routinely traveled the bulk of each week to get in front of people. Although some can't wait to hit the road again, others revel in the ability to reach more agents and brokers in less time virtually. Companies will likely be weighing multiple considerations before giving employees license to travel again, and curtailing travel when not absolutely necessary. There aren’t just health and safety concerns for having employees limit travel; companies that have slashed budgets are likely shaving unnecessary expenses.  

2. Expanding first-hand touchpoints with new audiences 

There's still an argument for the effectiveness of in-person sales meetings, but the pandemic has really opened up the lines of communication to the entire organization. That is, where maybe only one or two people might be in an in-person meeting, a virtual meeting gives the opportunity for multiple people to participate. It's a benefit most didn't realize would materialize when electronic calls became the go-to. There's a benefit to customers and employees to connecting first-hand, even virtually, over getting information relayed to them. 

3. Examining operations with an eye for efficiency 

Employees across the industry will be more attuned to how efficiently they work because of lessons learned during the pandemic. A decrease in travel and elimination of a commute free up chunks of time. Everyone will now also evaluated which meetings are truly important and which need to be face-to-face; some clients will prefer to permanently meet electronically. We have already seen a boom in technology advancements and uptake in the industry to help employees work efficiently while remote. 

4. Boosting take-up rates 

The changes forced on business by COVID-19 could increase insurance take-up rates, especially in an area like flood, where the new norms may reduce prices and increase the ease of transactions. What’s more, if there is one glaring lesson that we are learning from the pandemic, it is that the unexpected should be expected. Assessing and addressing risk – whether for businesses or homeowners – is top of mind as people strive to eliminate the potential impact of controllable surprises; for example, the aftermath of the Michigan floods this spring. 

5. Forcing modernization 

Some insurance agencies and brokers are welcoming the changes necessitated by the pandemic, while others started kicking and screaming that they would have to alter their operations. For example, agencies that discouraged a reliance on digital quickly had to change their tune, embrace how well old-style, mandatory two-hour Monday morning meetings could work on Zoom and update technology infrastructure from computer towers to laptops. Regardless of how advanced a company was in terms of digital acceptance, the pandemic has certainly forced those that were behind to catch up or risk the efficacy of their business in the long term. 

The next few weeks and months will likely bring more change and will bring even more clarity to how the industry will be permanently reshaped. There is great value in some of the changes we have seen – and anticipate to stay – and for those willing to be adaptable and flexible there can be great opportunity and growth.

Claims and Effective Risk Management

How you prioritize claims and related activities will have significant effects on how you can contribute to organizational success.

The cost of claims has been at the heart of Total Cost of Risk (TCOR) since even before the inception of risk management as a separate function. The sheer magnitude of losses, insurable or not, defines so much of what risk managers focus on and tends to be what they report on most often, as well. The nature of mature and, by inference, effective risk management programs has claim management as a key focus. While risk maturity is directly correlated with risk effectiveness, this latter term encompasses a much broader perspective on things that matter. 

Not surprisingly, many components of risk management maturity have some connection to effective claim management. Accordingly, it is appropriate to understand what these components are and how they dovetail with a more comprehensive view into effective risk management. Admittedly, this perspective relates most to the traditional practice of risk management, focused on hazard risk, but failure in this realm will likely point to failure in other areas of risk management.

Components of Risk Discipline 

To instill risk discipline, and, by extension, maturity into claim management, one must set the tone for effectiveness across the spectrum of risk management activities and significantly feed overall risk management performance. This tone will influence the ability of risk leaders to act as “trusted advisers” to organizational decision makers. This should be a key goal for risk leaders, critical to long-term effectiveness and functional sustainability.

The starting point for this subject is two key things. First, how one defines “risk” and drives a consensus among key stakeholders about that definition. Claims are, of course, the outgrowth of risk and exposure. This direct relationship is the essence of why claims and effective claims management have a direct relationship to effective risk management. Whether this aspect of the discipline gets done by insurers (as part of the insurance contract), insureds (as a part of a self-administered claim operation) or through third parties (independent adjusters, third party administrators etc.) makes little difference. Effective claim management feeds effective risk management.

The second issue is both which risks are your focus and where on the loss curve they fall. This may sound simple, but the reality is that many risk leaders have responsibilities for only a portion of the risks that organizations face; often only the insurable risks. If that’s the case, the need to focus on claim management is clear; one leads to the other.

The Basics of Effective Risk Management Maturity

If you are a risk leader with broad accountability for risks, then the first question of “what is a risk to your firm?” requires total clarity. For the purposes of this article, a good definition of risk is “uncertainty” as it relates to the accomplishment of objectives. This simple definition captures the most central element of concern — uncertainty. However, the real challenge is determining the amount of uncertainty (such as frequency/likelihood), as well as the level of impact or severity. Each risk leader must make this choice and get it validated by his or her organization.

While many leaders focused on hazard risk look at risks at actuarially “expected” levels of loss, the challenge is how far out on the tail one should manage. While the possibility of loss becomes increasingly remote as you move out toward the tail of the curve, the impact of events becomes more destructive. Because the magnitude of loss in this realm can be catastrophic, the importance of both preventing and mitigating these events and their impact becomes critical. Central to after-loss mitigation is the claim management process. Related key questions that every risk leader must answer include:

  • What matters more to your organization: likelihood or impact, or are they equal?
  • What level of investigation should you apply to less likely risks?
  • How do we apply typically limited resources to remotely likely risks?
  • Do you have a consensus among key stakeholders as to what risks to focus on and how?
  • Do you have or need an emerging risk identification process?
  • Do you have a consensus on and clear understanding of how you define risk in your organization?
  • Have you educated your organization on the correlations between losses, claims and risk effectiveness?

These questions are the starting point for ensuring risk management maturity. From your answers to these questions, you can chart your course for what this will mean to your firm. The answers will define the process elements of maturity that will be needed to achieve your desired state. But we need to define what risk maturity is to track progress toward this state and to ensure that stakeholders are aligned around the chosen components necessary to get there. Understanding the attributes of claims and risk maturity includes:

  • Managing exposures to specifically defined appetite and tolerances;
  • Management support for the defined risk culture that ties directly to the organizational culture;
  • Ensuring disciplined risk and claim processes aligned with other functional areas;
  • Creating a process for uncovering the unknown or poorly understood (aka emerging) risks;
  • Effective analysis and measurement of risk and claims both quantitatively and qualitatively; and,
  • A collaborative focus on a resilient and sustainable enterprise, which must include a robust risk and claim strategy.

See also: Future Is Already Here in Claims

Examples of Risk Management Maturity Models

One thoroughly developed risk management maturity model (RMM) comes from the Risk Management Society (RIMS). While it was developed some 10 years ago, it remains a simple, yet comprehensive view of the seven most important factors that inform risk maturity. When well implemented, these components should drive an effective approach to managing all risk within your purview. 

The components of the RIMS RMM model include:

  • Adopting an enterprise-wide approach that is supported by executive management and that is aligned well with other relevant functions;
  • The degree to which repeatable and scalable process is integrated in the business and culture;
  • The degree of accountability for managing risk to a detailed appetite and tolerance strategy;
  • The degree of discipline applied to using the elements of good root cause analysis;
  • The degree to which a robust emerging risk process is used to uncover uncertainties to goal achievement;
  • The degree to which the vision and strategy are executed considering risk and risk management; and,
  • The degree to which resiliency and sustainability are integrated between operational planning and risk process.

Like all risk management strategies, no two are exactly the same, and there is no one way to accomplish maturity. Importantly, every risk leader needs to do for his or her organization what the organization needs and will support. 

Of course, RIMS is not the only source of risk maturity measurement. Others, including Aon, offer other criteria. Aon’s model includes these components:

  • Ensuring the board understands and is committed to the risk strategy;
  • Effective risk communications;
  • Emphasis on the ties among culture, engagement and accountability;
  • Stakeholder participation in risk management activities;
  • The use of risk in/formation for decision making; and,
  • Demonstration of value.

This is not to say that the RIMS model ignores these issues, they simply take a different emphasis between the models. 

Another model worth considering is from Protiviti’s perspective on risk maturity as it relates to the board of director’s accountability for risk oversight. A few highlights of the perspective include:

  • An emphasis on the risks that matter most;
  • Alignment between policies and processes;
  • Effective education and use of people and their place in the organization;
  • Ensuring assumptions are supportable and understood;
  • The board’s knowledge of asking the right questions; and,
  • Understanding the relationship to capability maturity frameworks.

Certainly, good governance is critical to ultimate success, and the board’s role in that is the apex of that consideration. If the board is engaged and accountable for ensuring their risk oversight responsibility is effectively executed, the successful execution of the strategy is likely and, by inference, risk and related claims will have been effectively managed, as well.

Another critical aspect of the impact of risk and claims that should not be overlooked is their impact on productivity. If productivity is directly related to people’s availability to work, then we can quickly agree that risks produce losses that affect both people and property, oftentimes together. We can readily agree that impacts to productivity are a frequent result of losses and the claims they generate. Further, productivity impacts are not just limited to on-the-job injury. Every car accident, property loss or general liability loss that includes personal injury has implications for productivity, in either the workplace or outside of the workplace. As a result, it behooves all risk and claim leaders to execute their roles by aligning their interests and driving their focus.

Finally, a few fundamentals that are important to understand in execution of these goals include understanding that:

  • how you handle claims will directly affect not just your TCOR but your overall risk management capability and effectiveness; 
  • there is no one right approach to managing claims or risks; each organization must chart its own course aligned with its culture and priorities;
  • risk and the claims they can generate must be treated as an integral aspect of organizational strategy;
  • risk and claim management should be a focus on additive value; and,
  • risk and claim maturity have shown that better results are achieved as a result.

See also: How Risk Managers Must Adapt to COVID

In its simplest form, risk management is about preventing (or, on the upside, leveraging), financing and controlling risk and loss. Effective risk management is dependent on many elements, not least of which is effective claims management. And while claims are naturally focused on negative events that have already occurred, this activity is centrally critical to comprehensive, effective risk management.

How you prioritize claims and related activities will have significant effects on how you can contribute to organizational success. Doing both well will enable both risk and claim management effectiveness, demonstrated by measurable maturity.


Christopher Mandel

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Christopher Mandel

Christopher E. Mandel is senior vice president of strategic solutions for Sedgwick and director of the Sedgwick Institute. He pioneered the development of integrated risk management at USAA.